Rhinoplasty is one of the most popular plastic surgeries in the world. In pursuit of the ideal shape of the nose, patients go under the knife, not always realizing what consequences await them. Plastic surgeon Alexander Titov told the Omsk Here correspondent about the rehabilitation after surgery and why rhinoplasty is considered an operation for young people.
- What are the indications for rhinoplasty?
- There are two main indications. The first is dissatisfaction with the nose for aesthetic reasons, when the patient does not like the shape of the nose. The second is the consequences of trauma or previous illnesses, including those with respiratory failure. With age, this problem is aggravated, and at some point it begins to cause obvious inconveniences: the nose does not breathe, because of this, it dries in the mouth, and headaches appear. But here it is necessary to distinguish between plastic surgery and ENT surgery.
Correcting gross visual imperfections is required for a small number of people. Basically, patients are not satisfied with even minor deviations from the "ideal" shape of the nose; often, in their opinion, the nose simply does not fit the face. The nose does not seem to be such a large part of the face, but it strongly influences both the impression of a person from others and the perception of oneself, which means that even minimal changes in its shape lead to significant consequences. That's really really - surgery of millimeters!
- If a patient has a deviated nasal septum, is it worth doing septoplasty and in what cases, in your opinion?
- When it comes only to a violation of nasal breathing, and nothing else bothers you, then you need to contact an ENT doctor, do septoplasty, and this is not quite our direction.
In cases where it is planned to first align the nasal septum and later, after a few years, change the shape of the nose, I recommend combining these operations into one. If septoplasty was performed before the operation to change the shape of the nose, then it will be more difficult for the surgeon to work in such conditions. This is due to the fact that we take a part of the nasal septum and use it for our manipulations to give one or another shape to the nose. And if a person is not going to change shape, then it is necessary to correct the nasal septum as early as possible, because this significantly affects the quality of life.
- What are the contraindications for rhinoplasty?
- There are quite a few of them. For example: the acute phase of infectious diseases, some chronic diseases such as diabetes mellitus, blood clotting disorders, oncopathology. Nevertheless, not all chronic diseases are contraindications, for example, many patients think that the presence of arterial hypertension is a contraindication, but in practice this is not always the case.
I would single out the main contraindication for this operation - the patient's psychological unwillingness to take such a crucial step as rhinoplasty. If, in a conversation with a patient, I understand that his requirements are redundant, do not correspond to reality, then I explain: the nose is not plasticine, and it will not work to "mold" anything out of it. Everyone's tissues (skin, cartilage and bones) are different, so it's not always realistic to do it like in the photographs of actresses that patients sometimes bring. Even if this can be done purely technically, it is not a fact that such a nose will fully breathe. I prefer to find out from the patient what the requests are, and if I see a doubt whether it is necessary to have an operation, I say: "Go home, think again, consult with loved ones and decide whether you really need it."Some people expect that the surgeon will tell himself whether such an operation is needed or not, but at this stage I prefer to be a neutral party. I can simulate the shape of the nose, talk about how the nose will look after the operation, describe the technique and possible complications, but the final decision, whether an operation is needed, should be up to the patient.
- What are the consequences after the operation?
- We need to prepare for the fact that the rehabilitation period is quite long. The final result after the operation can be seen only after six months or a year. You will have to go through bruises and swelling, perhaps there will be a temporary violation of nasal breathing. If the patient does not follow the recommendations of the surgeon or there are complicating factors such as chronic diseases, then inflammation may appear. The most common complication is postoperative nasal deformity. If the surgeon did the operation correctly, then there will be no significant disturbance of the shape and function of the nose, and if minor flaws suddenly appear, they are easily eliminated.
- What are the most common requests from patients?
- I was never asked to make the nose bigger, more authentic, to add a hump. Basically, they ask to shorten the nose, narrow the tip, remove the hump, make the nose symmetrical. There are sometimes unusual cases when there is some kind of serious injury, for the elimination of the consequences of which a special approach is required.
Men have more specific, pragmatic requests when there is a problem and it is obvious.
Of course, there were situations when it was necessary to dissuade people from the operation. If a person has an ideal nose from the point of view of the golden section of the face, the correct proportions and I understand that I will not improve it, then I refuse to carry out the operation.
- Why is rhinoplasty considered one of the most dangerous plastic surgeries?
- The main problem is postoperative deformity, which can be avoided by following all the doctor's recommendations, as well as monitoring the course of rehabilitation with an individual approach to each specific case. In general, I can say that the rhinoplasty that is being performed now is safer than the operations that were performed a decade earlier.
- How is the operation going? How long does it last?
- If we do traditional rhinoplasty, changing several parts of the nose at once, it takes two to four hours. I do such operations under general anesthesia. Of course, if this is work only with the tip or with the wings of the nose, then the operation can be performed under local anesthesia. A lot of time during the operation itself is devoted to quality control: we make sure that the symmetry is preserved, so that the nose breathes, we check with what we have modeled.
I must make a remark that patients sometimes come to the first consultation with dissatisfaction with some particular parameter, for example, the nose seems too long, and he thinks that it only needs to be shortened, and that's it. Changing only one parameter rarely leads to a harmonious looking nose, in most cases a more complex and therefore more time-consuming operation is required than initially thought.
- What to do if the patient is dissatisfied?
- The main task of the surgeon in this case is to determine what exactly the person does not like. Because there are the following situations: the nose, from the point of view of surgery, we did it perfectly, from the point of view of the modeled result, everything is fine and in about the same way as we drew. And the patient can still say: "Well, not mine!" We need to figure out what the problem is. Perhaps the adaptation to the new look has not yet taken place. It is clear that when after two or three weeks you go to the mirror and do not recognize yourself, it is hard for the psyche. A person must get used to himself in a new image, relatives must get used to it. For example, in the family, the daughter underwent rhinoplasty, and the parents got used to the appearance of their child in their entire life and now they do not recognize him. It is good if loved ones support in the postoperative period, and if they perceive this operation as some kind of whim, they say that it was better before, then this, of course, sits in the person himself and gnaws at him from the inside. If at home they said that everything is fine, then the patient would have a different attitude to the result obtained.
When there is a clear defect, the nose can be corrected. If there are no objective problems, then I recommend having patience and distraction. Over time, the new nose will definitely like it.
- How often does the need for a second operation arise?
- This happens very rarely, mainly with injuries to the nose after surgery. For example, one patient came back after a champagne cork flew into her nose after rhinoplasty. This led to a deviation of the nasal septum, nosebleeds. There have been cases when patients accidentally hit themselves in the nose with a door when they opened it. Even in this case, there can be no irreparable situation.
- What is the best age for rhinoplasty?
- Often people do not apply at the right time: up to 18 years old or over the age of 40-45 years. Rhinoplasty is considered to be an operation for young people. I have repeatedly had to refuse 50-60-year-old patients, given the risks of possible complications. Nevertheless, there are exceptions here, such issues are resolved individually. Most often, plastic surgeries are seasonal in nature: they are done in the summer, when people are on vacation and there is time for recovery, or before the New Year.
- Can the nose change shape over time?
- Yes, certain changes may occur. Considering that the rehabilitation period is very long, we say that the nose changes its shape over the course of a year or a year and a half - this is normal. If the operation is carried out correctly, then various techniques are used, aimed not only at obtaining a good result immediately, but also at preventing possible deformations in the future. For this, special "ribs of rigidity", props are made. From this point of view, the operated nose will be even more stable in the long term. To give an example: the tip of the nose sinks over time in most people, and the operated nose is more stable and should not move anywhere.
Photo: Ilya Petrov
